Medicine Flashcards
Medication for metastatic hepatocellular cancer?
Sorafenib
When is denosumab prescribed in cancer?
When 2 bisphosphonates have failed
When is interferon-alpha used as a tx?
Hep B and C
Kaposi’s sarcoma
Metastatic renal cell cancer
Hairy cell leukaemia
What is infliximab used for?
refractory and fistulating Crohn’s disease
How is severity of UC flare graded?
mild: < 4 stools/day, only a small amount of blood
moderate: 4-6 stools/day, varying amounts of blood, no systemic upset
severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)
Tx for mild to moderate proctitis?
Topical (rectal) aminosalicylate (mesalazine)
If remission is not achieved within 4 weeks + oral aminosalicylate
If remission still not achieved + topical or oral corticosteroid
Tx for mild to moderate proctosigmoiditis or left-sided UC?
Topical (rectal) aminosalicylate
If remission is not achieved within 4 weeks, + high-dose oral aminosalicylate OR switch to high-dose oral aminosalicylate + topical corticosteroid
If remission still not achieved stop topical tx and offer oral aminosalicylate + oral corticosteroid
Tx for mild to moderate extensive UC?
Topical (rectal) aminosalicylate + high-dose oral aminosalicylate:
If remission is not achieved within 4 weeks, stop topical treatments and offer a high-dose oral aminosalicylate + oral corticosteroid
Tx for severe UC?
Admit
IV steroids
IV ciclosporin
Maintenance tx for UC?
Oral/topical salicylates
If severe relapse/2+ exacerbations:
+ Azathioprine PO
+ Mercaptopurine PO
Most common extra-colonic malignancy of HNPCC?
Endometrial
Drugs known to induce TEN?
phenytoin sulphonamides allopurinol penicillins carbamazepine NSAIDs
What is a Curlings Ulcer?
Stress ulcers may occur in the duodenum of burns patients and are more common in children
4 features of Horner’s syndrome?
miosis (small pupil)
ptosis
enophthalmos* (sunken eye)
anhidrosis (loss of sweating one side)
Causes of obstructive lung disease?
Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans
Causes of restrictive lung disease?
Pulmonary fibrosis Asbestosis Sarcoidosis Acute respiratory distress syndrome Infant respiratory distress syndrome Kyphoscoliosis e.g. ankylosing spondylitis Neuromuscular disorders Severe obesity
Tx for life-threatening Clostridium difficile infection?
ORAL vancomycin
IV metronidazole
What is Conduction dysphasia?
Where is the defect?
speech fluent, but repetition poor. Comprehension is relatively intact supramarginal gyrus (parietal lobe)
Why do patients with coeliac disease require regular immunisations?
functional hyposplenism
Which organism most commonly causes peritonitis secondary to peritoneal dialysis?
Coagulase-negative Staphylococcus (Staphylococcus epidermidis)
Indications for wide local excision of breast tumour?
Solitary lesion
Peripheral tumour
DCIS <4cm
Small lesion in large breast
Indications for mastectomy?
Multifocal tumour
Central tumour
Large lesion in small breast
DCIS >4cm
Tx for ascending cholangitis?
IV Abx (piptaz) ERCP after 24 - 48 hours
Drugs to stop in AKI? (DAMN)
Diuretics
Aminoglycosides and ACE inhibitors
Metformin
NSAIDs
What tx for ascites?
Conservative: salt restrict
Medical: Spironolactone or amiloride +/- abx prophylaxis for SBP
Surgical: therapeutic abdominal paracentesis (if tense ascites)
TIPS in some cases
Light’s criteria for transudate/exudate?
Only used if protein 25-35g/L
Protein >30g/L = exudate
Protein <30g/L = transudate
ALSO fluid is exudate if:
pleural fluid protein divided by serum protein >0.5
pleural fluid LDH divided by serum LDH >0.6
pleural fluid LDH more than two-thirds the upper limits of normal serum LDH
What needs to be checked before starting terbinafine?
LFTs
Morphine conversions to know?
Weak Opioids are 10 TIMES WEAKER than Oral Morphine
Subcutanous Morphine is TWICE AS STRONG as Oral Morphine
Oral Morphine is TWICE AS STRONG as Oral Oxycodone (bnf uses 1.5)
Oral codeine is 10 TIMES WEAKER than Oral Morphine
PRN dose should be 1/6th dose of total daily dose
Morphine SUSTAINED release you should divide immediate release dose by 2
When to refer a burn to secondary care?
all deep dermal and full-thickness burns.
superficial dermal burns of more than 3% TBSA in adults, or more than 2% TBSA in children
superficial dermal burns involving the face, hands, feet, perineum, genitalia, or any flexure, or circumferential burns of the limbs, torso, or neck
any inhalation injury
any electrical or chemical burn injury
suspicion of non-accidental injury
What does the SAAG tell you in ascites?
If it is caused by portal HTN
A raised SAAG (>11g/L) = portal hypertension
Causes of Budd Chiari syndrome?
polycythaemia rubra vera
thrombophilia: activated protein C resistance, antithrombin III deficiency, protein C & S deficiencies
pregnancy
COCP
How does myocarditis present?
ST elevation and acute pulmonary oedema in a young patient with a recent flu-like illness
What ix confirms C diff colitis?
Stool C diff Toxin
Causes of a normal anion gap or hyperchloraemic metabolic acidosis? ABCD
Addison’s disease
Bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula, renal tubular acidosis, diuretics
Chloride: ammonium chloride injection, NaCl
Drugs: acetazolamide
Causes of a raised anion gap metabolic acidosis? MUDPILES
lactate: shock, hypoxia
ketones: diabetic ketoacidosis, alcohol
urate: renal failure
acid poisoning: salicylates, methanol
5-oxoproline: chronic paracetamol use
Methanol Uraemia (in CKD) Diabetic ketoacidosis Paracetamol Isoniazid/iron Lactate Ethylene glycol (antifreeze) Salicylates
What QRISK score should tx be started?
10%
Atorvastatin 10mg
What might cause a falsely low HbA1c?
Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
Blood donation
What might cause Higher-than-expected levels of HbA1c?
Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy
How much should once daily insulin be reduced the day before and on the day of surgery?
20%
Causes of drug induced cholestasis?
COCP
Abx: flucloxacillin, co-amoxiclav, erythromycin*
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
fibrates
rare reported causes: nifedipine
Causes of erythema nodosum?
infection - streptococci - TB - brucellosis systemic disease - sarcoidosis - IBD - Behcet's malignancy/lymphoma drugs - penicillins - sulphonamides - COCP pregnancy
SE of vincristine?
Peripheral neuropathy
SE of bleomycin?
Lung fibrosis
SE of doxorubicin?
Cardiomyopathy
Cause in young female patients who develop AKI after the initiation of an ACE inhibitor?
Fibromuscular dysplasia
Causes of secondary HTN?
ENDOCRINE Cushing's Conn's Phaeo Acromegaly Hypothyroid
RENAL
Polycystic kidney disease
VASCULAR
Renal artery stenosis
Coarctation of aorta
Clinical signs of SVCO?
facial swelling and erythema distended neck and chest wall veins (non-pulsatile) arm swelling and distended arm veins papilloedema (a late sign) stridor (if severe) cyanosis (less common)
Which antiemetic in opioid induced nausea?
Metoclopramide
Which antiemetic in chemo/radiotherapy induced nausea?
Ondansetron
What conditions are associated with osteosclerosis?
Prostate cancer mets
Sickle cell disease
Breast Ca mets
Initial tx for metastatic prostate Ca?
gonadotrophin-releasing hormones
When considering whether a patient should be referred for a chest x-ray, what do the NICE guidelines for the diagnosis of lung cancer define as the duration of a persistent cough/haemoptysis or other symptom?
> 3 weeks
Causes of a cavitating lung lesion?
Cavitating pneumonia Septic emboli (bacterial or fungal) Wegener’s granulomatosis or pulmonary vasculitis Pulmonary infarction Infected bullae or cysts Neoplasia: primary or secondary
1st line tx in prophylaxis of variceal bleeds?
Non-cardioselective beta-blockers
Duration of tx in autoimmune hepatitis?
At least 2 years after normalisation of LFTs
CIs to using loperamide?
Bloody stools
Fever
Abx associated colitis
Metabolic findings in tumour lysis syndrome?
Hyperkalaemia
Hyperphosphataemia
Hyperuricaemia
Hypocalcaemia
Indications for dialysis?
Uraemic encephalopathy
Refractory hyperkalaemia
Refractory metabolic acidosis
Pulmonary oedema with oliguria
1st line tx for patients with both hypertension and albuminuria?
ACEi
Most common cause of nephrotic syndrome in adults? What would you see on light microscopy and silver staining?
Membranous glomerulonephritis
Light microscopy: Thickened basement membrane
Silver staining: Sub-epithelial spikes
What should a recurrent episode of C. difficile within 12 weeks of symptom resolution should be treated with?
oral fidaxomicin
management of Crohn’s patients who develop a perianal fistula?
Oral metronidazole
What verterbral levels do the coeliac trunk, SMA, IMA and ovarian/testicular arteries originate?
t12 = Coeliac trunk has 12 letters L1 = SMA “S for Single” L2 = testis/ovarian artery (we have two testis/ovaries) L3 = IMA
What score is to assess risk of pressure sore?
Waterlow
What score is to assess risk of malnutrition?
MUST
Define malnutrition
BMI < 18.5
unintentional weight loss >10% within the last 3-6 months
BMI < 20 and unintentional weight loss > 5% within the last 3-6 months
Tx for achalasia?
Heller cardiomyotomy
Gene in FAP?
APC
Gene in HNPCC?
MSH2/MLH1
RFs for Focal segmental glomerulosclerosis?
idiopathic secondary to other renal pathology e.g. IgA nephropathy, reflux nephropathy HIV heroin Alport's syndrome sickle-cell
Cancers with raised platelets? LEGO-C
- Lung
- Endometrial
- Gastric
- Oesophageal
- Colorectal
What do we use to monitor tx in haemochromatosis and what is the characteristic iron study profile?
Ferritin and transferrin saturation (1st line)
Would expect a raised transferrin saturation and ferritin, with low TIBC
Tx for haemochromatosis and aims?
Venesection
transferrin saturation should be kept below 50% and the serum ferritin concentration below 50 ug/l
What do you see on xray in haemochromatosis?
Joint x-rays characteristically show chondrocalcinosis
Causes of cranial DI?
idiopathic post head injury pituitary surgery craniopharyngiomas histiocytosis X DIDMOAD is the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram's syndrome) haemochromatosis
Causes of nephrogenic DI?
genetic: the more common form affects the vasopression (ADH) receptor, the less common form results from a mutation in the gene that encodes the aquaporin 2 channel
electrolytes: hypercalcaemia, hypokalaemia
Drugs: lithium, demeclocycline
tubulo-interstitial disease: obstruction, sickle-cell, pyelonephritis
most important HLA to match in renal transplantation?
HLA DR > B > A
When do NICE guidelines suggest referring to a nephrologist from primary care in CKD?
if eGFR falls below 30 or progressively by > 15 in a year
AKI Stage 1?
Increase in creatinine to 1.5-1.9 times baseline, or
Increase in creatinine by ≥26.5 µmol/L, or
Reduction in urine output to <0.5 mL/kg/hour for ≥ 6 hours
AKI Stage 2?
Increase in creatinine to 2.0 to 2.9 times baseline, or
Reduction in urine output to <0.5 mL/kg/hour for ≥12 hours
AKI Stage 3?
Increase in creatinine to ≥ 3.0 times baseline, or
Increase in creatinine to ≥353.6 µmol/L or
Reduction in urine output to <0.3 mL/kg/hour for ≥24 hours, or
The initiation of kidney replacement therapy, or,
In patients <18 years, decrease in eGFR to <35 mL/min/1.73 m2
Causes of a raised TLCO (transfer capacity)
asthma pulmonary haemorrhage (Wegener's, Goodpasture's) left-to-right cardiac shunts polycythaemia hyperkinetic states male gender, exercise
Causes of a lower TLCO
pulmonary fibrosis pneumonia pulmonary emboli pulmonary oedema emphysema anaemia low cardiac output
Some conditions may cause an increased KCO with a normal or reduced TLCO?
pneumonectomy/lobectomy
scoliosis/kyphosis
neuromuscular weakness
ankylosis of costovertebral joints e.g. ankylosing spondylitis
palliative pain relief in severe renal impairment?
egfr <10 = fentanyl/buprenorphine, 10-50 = oxycodone, >50 = morphine
What ix for PSC?
ERCP/MRCP (first line)
What does proteinuria on dipstick in context of aki mean?
Intrinsic renal injury
Anion gap formula?
Na+ K - (Bicarb + Cl)
Tx for proteinuria in CKD?
ACEi/ARB if they have an ACR > 30 mg/mmol
Acute interstitial nephritis presentation?
Fever and rash
Renal impairment
HTN
Urine dip: high white cells/eosinophilic casts
Bloods: raised serum creatinine and eosinophilia
Threshold for severe hypokalaemia for IV tx?
<2.5mmol/L
What disease gives this picture? prolonged bleeding time increased APTT normal PT normal platelet count
Von Willebrand
What disease gives this picture? normal bleeding time increased APTT normal PT normal platelet count
Haemophilia
Typical findings in type 2 renal tubular acidosis?
Hypokalaemia
Osteomalacia
How to convert from oral morphine to diamorphine?
Total daily morphine DIVIDED by 3
What electrolyte abnormality does long term PPI tx cause?
Hypomagnesemia
the only recommended test for H. pylori post-eradication therapy?
Urea breath test
Why is nephrotic syndrome associated with hypercoagulability?
Loss of antithrombin III via kidneys
What does urine sodium > 40 mmol/L suggest?
ATN
Granulomatosis with polyangiitis features?
pulmonary haemorrhage (haemoptysis), renal impairment (rapidly progressive glomerulonephritis) and flat or saddle nose (due to a collapse of the nasal septum)
SBP acute abx and prophylactic (ascites + protein<15) abx?
Acute: IV cefotaxime
Prophylactic: ciprofloxacin
Most common extra renal manifestation of ADPKD?
Liver cysts
Mx of severe alcoholic hepatitis?
Prednisolone
Why might you see hyaline casts in urine?
If a pt takes loop diuretics
causes of Rapidly progressive glomerulonephritis?
Goodpasture’s syndrome
Wegener’s granulomatosis
others: SLE, microscopic polyarteritis
causes of Exudative pleural effusion? (> 30g/L protein)
infection: pneumonia (most common exudate cause), TB, subphrenic abscess
connective tissue disease: RA, SLE
neoplasia: lung cancer, mesothelioma, metastases
pancreatitis
pulmonary embolism
Dressler’s syndrome
yellow nail syndrome
causes of transudative pleural effusion? (< 30g/L protein)
heart failure (most common transudate cause)
hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption)
hypothyroidism
Meigs’ syndrome
Which cancer leads to cannon ball mets in the lungs?
Renal cell carcinoma
Investigations of small bowel bacterial overgrowth syndrome?
Hydrogen breath test
Small bowel aspiration and culture: this is used less often as invasive and results are often difficult to reproduce
Clinicians may sometimes give a course of antibiotics as a diagnostic trial
Risk factors for SBBOS?
neonates with congenital gastrointestinal abnormalities
scleroderma
diabetes mellitus
Mx of SBBOS?
correction of underlying disorder
antibiotic therapy: 1st line = rifaximin (Co-amoxiclav or metronidazole are also effective)
Causes of minimal change disease?
Idiopathic
Drugs: NSAIDs, rifampicin
Cancer: Hodgkin’s lymphoma, thymoma
Infection: infectious mononucleosis
Urinary sodium and osmolality in pre-renal AKI?
Low urine sodium <20
High urine osmolality
When do you see brown casts in urine?
Acute tubular necrosis
Urinary sodium and osmolality in ATN?
High urine sodium >40
Low urine osmolality
Adenocarcinoma of the lung paraneoplastic syndromes?
Gynaecomastia
Hypertrophic pulmonary osteoarthropathy
Causes of upper lobe pulmonary fibrosis?
C- Coal worker's pneumoconiosis H - Histiocytosis/ hypersensitivity pneumonitis A - Ankylosing spondylitis R - Radiation T - Tuberculosis S - Silicosis/sarcoidosis
characteristic pleural fluid findings for glucose, amylase and blood staining?
low glucose: rheumatoid arthritis, tuberculosis
raised amylase: pancreatitis, oesophageal perforation
heavy blood staining: mesothelioma, pulmonary embolism, tuberculosis
Ix for pleural effusion?
PA CXR
USS guided aspiration
Consider contrast CT
How do you know if it is cardiac pulmonary oedema?
pulmonary capillary wedge pressure raised
What does melanosis coli (pigment-laden macrophages) on colonoscopy histology suggest?
Laxative abuse
cholestatic jaundice, raised IgM and positive anti-mitochondrial M2 antibodies - dx?
PBC
1st and 2nd line tx in PBC?
Ursodeoxycholic acid (slows disease progression so give even if asymptomatic) Obeticholic acid
When might liver transplant be considered in PBC?
If bilirubin >100
What is a Dieulafoy lesion?
abnormally large artery in the lining of the GI system - most common 6 cm from the O-G junction on the lesser curve of the stomach
What can aggressive fluid resus with NaCl cause?
hyperchloraemic metabolic acidosis
What sign may be seen on CT of pancreatic cancer?
Double duct sign
What is a patient’s glucose requirement?
50-100 g/day irrespective of the patient’s weight
What type of nephropathy is associated with cancer?
Membranous nephropathy
Tx of nephrogenic DI?
hydrochlorothiazide
Contraindications to lung cancer surgery?
SVC obstruction
FEV < 1.5
MALIGNANT pleural effusion
vocal cord paralysis
time taken for an arteriovenous fistula to develop?
6 to 8 weeks
Extra-renal features of ADPKD?
Hepatic cysts which manifest as hepatomegaly
Diverticulosis
Intracranial aneurysms
Ovarian cysts
Initial management of CKD-mineral bone disease?
Correct hyperphosphataemia first; start with dietary changes before starting a phosphate binder
Tx for Hiccups in palliative care?
chlorpromazine or haloperidol
6 tests to confirm brain death?
pupillary reflex, corneal reflex, oculo-vestibular reflex, cough reflex, absent response to supraorbital pressure, and no spontaneous respiratory effort
Rhabdomyolysis value for it to cause AKI?
5x upper limit of normal
What to do if someone comes in with ascites with other symptoms e.g. fever/confusion etc and why?
Ascitic tap
Rule out SBP
Tx of PE if recent bleeding history?
IV heparin (easier to reverse than SC)
When do we use IVC filter?
Recurrent PE
PE despite anticoagulation
Rigler’s triad for gallstone ileus?
Air in bile ducts
Gallstone visible outside gallbladder
Small bowel obstruction
How is liver cirrhosis screened for? What are the indications?
transient elastography (Fibroscan)
people with hepatitis C virus infection
men who drink over 50 units of alcohol per week and women who drink over 35 units of alcohol per week and have done so for several months
people diagnosed with alcohol-related liver disease
How is hepatocellular carcinoma screened for? What are the indications?
Liver USS
patients liver cirrhosis secondary to hepatitis B & C or haemochromatosis
men with liver cirrhosis secondary to alcohol
Gold standard ix in achalasia? What would it show?
High resolution oesophageal manometry
- Elevated resting LOS pressure (>45 mmHg)
- Incomplete LOS relaxation
- Absence of peristalsis in smooth muscle portion of the oesophagus
what is carbohydrate-deficient transferrin used for?
very specific biomarker for heavy alcohol use
Indication for prophylactic abx in ascites and what would you give?
Oral ciprofloxacin
Patients with cirrhosis + ascites with an ascitic protein of 15 g/litre or less, until the ascites has resolved
Grading of hepatic encephalopathy?
Grade I: Irritability
Grade II: Confusion, inappropriate behaviour
Grade III: Incoherent, restless
Grade IV: Coma
Mx of CKD mineral bone disease?
reduced dietary intake of phosphate is the first-line management
phosphate binders: sevelamer
vitamin D: alfacalcidol, calcitriol
parathyroidectomy may be needed in some cases
Tx for allergic bronchopulmonary aspergillosis?
Oral Glucocorticoids
Indications for NIV?
COPD with respiratory acidosis pH 7.26-7.35, CO2 >6kpa
type II respiratory failure secondary to chest wall deformity, neuromuscular disease or obstructive sleep apnoea
cardiogenic pulmonary oedema unresponsive to CPAP
weaning from tracheal intubation
Criteria for dx of myeloma?
Monoclonal plasma cells in the bone marrow >10%
Monoclonal protein within the serum or the urine (as determined by electrophoresis)
Evidence of end-organ damage e.g. hypercalcaemia, elevated creatinine, anaemia or lytic bone lesions/fractures
What is PBC associated with?
Sjogren’s
Rheumatoid arthritis
Staging of sarcoid xray?
Stage 0: normal Stage 1: bilateral hilar lymphadenopathy Stage 2: bilateral hilar lymphadenopathy + lung involvement Stage 3: lung involvement only Stage 4: lung fibrosis
Tx in haemochromatosis?
- Venesection
2. Desferrioxamine
Mesenteric ischaemia triad?
CVD, high lactate and soft but tender abdomen
Tx of Bile-acid malabsorption? Watery green diarrhoea after cholecystectomy?
Cholestyramine
What to do if dysplasia is found on biopsy in Barrett’s oesophagus?
Endoscopic mucosal resection
Alcoholic ketoacidosis mx?
IV thiamine + 0.9% saline
What type of cancer does achalasia increase your risk of?
SCC of oesophagus
Investigation of choice for suspected perianal fistulae in patients with Crohn’s?
MRI pelvis
2 scores for assessing risk in an upper GI bleed before endoscopy?
AIMS65 - risk of in-hospital mortality
Glasgow-Blatchford - before a procedure to determine whether ‘low-risk’ patients need admission or not
What might sudden weight loss cause in patients with NASH?
An exacerbation - raised LFTs and bilirubin
Deficiencies in coeliac disease?
Iron
B12
Folate - big one
Gene in Wilson’s?
Findings on copper studies?
ATP7B gene on Chr13
Low serum copper
Low serum caeruloplasmin
increased 24hr urinary copper excretion
Mx of variceal bleed?
- Terlipressin + IV Abx
- Endoscopy: band ligation > sclerotherapy
- Sengstaken-Blakemore if uncontrolled bleed
- TIPSS
When to drain a pleural effusion in infection?
If diagnostic pleural fluid sampling shows:
Purulent/turbid fluid
Clear fluid with pH <7.2
Features of acute bronchitis?
cough: may or may not be productive sore throat rhinorrhoea wheeze No focal signs O/E
Tx of acute bronchitis?
Mainly conservative
Consider abx - doxycycline if:
systemically unwell
CRP >100 (consider delayed prescription if 20-100)
When to intubate in COPD?
When pH <7.25
Tx for type 2 resp failure in COPD?
controlled o2 therapy - 24% o2 [resp could be driven by hypoxic drive ie. resp centre insensitive to co2] Target spo2 88-92%
- recheck abg after 20 mins, if CO2 is lower or steady increase O2 to 28%
- if CO2 has risen >1.5kpa and patient is still hypoxic consider assisted ventilation or doxapram
- in rare case if this fails -> intubation
Who to start bisphosphonates in?
- Anyone with a BMD 7.5mg for >3months)
Indications for surgery in bronchiectasis?
Localised disease
Uncontrollable haemoptysis
Truelove and Whitt’s criteria for severe UC flare?
Blood in stools and >6 stools per day AND T - Temp > 37.8 R - Rate > 90 U - (Uh)naemia Hb < 105 E - ESR >30
Vit D supplement in end stage renal failure?
Alfacalcidol - doesn’t require activation
Acceptable rise in creatinine/fall in GFR with ACEi?
decrease in eGFR of up to 25%
rise in creatinine of up to 30% is acceptable
How to step down asthma tx?
aim for a reduction of 25-50% in the dose of inhaled corticosteroids
Diagnostic criteria for asthma?
Exhaled FeNO of >/= 40 parts per billion
Post-bronchodilator improvement in lung volume of 200 ml
Post-bronchodilator improvement in FEV1 of >/= 12%
Diurnal Peak Flow variability of >/= 20%
FEV1/FVC ratio <70%
Tx for hepatorenal syndrome?
Albumin + terlipressin
What needs to be co-administered when doing a a large volume paracentesis with an ascitic drain?
IV albumin
Reduces paracentesis-induced circulatory dysfunction and mortality
definition of an Upper GI Bleed?
haemorrhage with an origin proximal to the ligament of Treitz
Tx for small bowel bacterial overgrowth syndrome?
Rifaximin
Relative contraindications for inserting a chest drain?
INR > 1.3
Platelet count < 75
Pulmonary bullae
Pleural adhesions
Indications for inserting a chest drain?
Pleural effusion
Pneumothorax not suitable for conservative management or aspiration
Empyema
Haemothorax
Haemopneumothorax
Chylothorax
In some cases of penetrating chest wall injury in ventilated patients
When should tx with bisphosphonates be re-evaluated?
After 5 years of oral bisphosphonates
After 3 years for IV zoledronate
Repeat DEXA and FRAX
What platelet levels should be aimed for pre-op?
> 50×109/L for most patients
50-75×109/L if high risk of bleeding
100×109/L if surgery at critical site
